Failure Of Conservative Measures Research Articles

Ultherapy Shrinks Nasal Skin after Rhinoplasty following Failure of Conservative Measures

Ultherapy Shrinks Nasal Skin after Rhinoplasty following Failure of Conservative Measures

Spontaneous Intracranial Hypotension: Characteristics of the Serious Form in a Series of 24 Patients

Recommended treatments for spontaneous intracranial hypotension (SIH) range from bed rest only to neurosurgery. However, the serious form of SIH is poorly defined. A better description of patient characteristics and their outcome may help define therapeutic options. We reviewed 24 cases of patients with SIH and separated them into 2 groups according to whether or not they presented with signs of severity at admission: disturbance of consciousness, subdural hematomas (SDHs), and cerebral venous thrombosis. Nine patients (37%) were classified as having a serious form of SIH: six (25%) presented SDHs; three (12%) disturbance of consciousness; and one (4%) cerebral venous thrombosis. Bed rest and epidural blood patches (EBPs) were sufficient to treat all patients in the nonserious form group and 4 patients in the serious form group. Two patients (8%) had to undergo cerebrospinal fluid leak repair, and 3 others (12%) evacuation of SDHs. Outcome was good in both groups, with only one (4%) death due to extensive SDHs. Times to diagnosis in the serious form group (63 vs. 35 days, P = 0.052) and to recovery (9 months vs. 5 months, P = 0.088) tended to be higher without reaching difference. The presence of SDHs, disturbance of consciousness, and a trend toward a longer time to diagnosis and recovery seem to define the serious form of SIH. These patients may require exploration and surgical repair of cerebrospinal fluid leak, only after failure of conservative measures--bed rest and time--and EBP, with good outcome.

MP20-20 CYSTECTOMY FOR REFRACTORY HEMORRHAGIC CYSTITIS: CONTEMPORARY ETIOLOGY, PRESENTATION AND OUTCOMES

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder II1 Apr 2015MP20-20 CYSTECTOMY FOR REFRACTORY HEMORRHAGIC CYSTITIS: CONTEMPORARY ETIOLOGY, PRESENTATION AND OUTCOMES Brian Linder, Robert Tarrell, and Stephen Boorjian Brian LinderBrian Linder More articles by this author , Robert TarrellRobert Tarrell More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.992AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the clinical presentation, management and outcomes for patients undergoing cystectomy for refractory hemorrhagic cystitis. METHODS We identified 21 patients with refractory hematuria treated with cystectomy at our institution between 2000–2012. Prior to cystectomy, all patients had failed clot evacuation, bladder fulguration, and bladder irrigation. Additionally, 45% had received prior intravesical therapy (Amicar, Alum, or Formalin), hyperbaric oxygen therapy (25%), nephrostomy tube placement for attempted urinary diversion (15%), and/or selective bladder angioembolization (5%). Survival was estimated using the Kaplan Meier method and compared with the log-rank test. RESULTS Median patient age at surgery was 77 years (IQR 72,80), while 81% (17/21) were male. The most common etiology for hemorrhagic cystitis was prior radiation therapy for prostate cancer (17; 81%). Median time from receipt of radiation to cystectomy in these patients was 91 months (IQR 73,125). Median American Society of Anesthesiologists Score at cystectomy was 3, while the median pre-operative hemoglobin was 10.2 g/dL. Median length of stay following cystectomy was 10 days (IQR 7, 19). Severe (Clavien Grade III-V) complications were noted in 42% of patients (8/19) and the 90-day mortality rate in this cohort was 16% (3/19). With a median postoperative follow-up of 13 months (IQR 4, 21) the 1 and 3-year overall survival for those undergoing cystectomy for hemorrhagic cystitis was 84% and 52%, respectively. Interestingly, when compared to a matched cohort of patients with pT0 bladder cancer at cystectomy (1:1), no statistically significant difference in overall survival was found between the cohorts (p=0.38). CONCLUSIONS Cystectomy for hemorrhagic cystitis is associated with a high risk of perioperative complications and mortality, consistent with the baseline clinical status of this patient cohort, and as such should remain a last resort to control bleeding after failure of conservative measures. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e231 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Linder More articles by this author Robert Tarrell More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of fixed-bearing arthroplasty in primary total knee replacement

Background Fixed-bearing primary total knee replacement is a well-established method of treatment for advanced arthritic knee joint. Aim of the study This study evaluated the clinical, functional, and radiological outcomes after the use of fixed-bearing total knee arthroplasty in cases of primary total knee replacement. Patients and method This prospective study was conducted on 14 patients (six male and eight female) who attended Suez Canal University Hospitals between January 2012 and January 2013, and the mean age was 60 years (range 50-72 years) at the time of surgery. The patients included in the study had advanced unilateral knee osteoarthritis with severe pain and functional disability with failure of conservative measures. Preoperative clinical and radiological evaluation was carried out and the knee society clinical and functional rating system (KSS) was used to evaluate the patients preoperatively and postoperatively at 1-year follow-up. The scoring system combines a relatively objective knee score that is based on the clinical parameters and a functional score based on how patients perceive their knee function in relation to specific activities. Radiological evaluation was carried out to determine the alignment of the knee and the femoral and tibial component positions. Results There was significant difference between preoperative and postoperative clinical and functional scores. The mean postoperative clinical assessment score for pain was 44.9, for range of motion it was 115.9, and for stability it was 23.5. Postoperative mean knee society clinical assessment score was 90.7 and the mean functional assessment score for knee function was 87.5. According to the knee society clinical and functional score, 85% of patients had excellent results and 15% of patients had good results. As regards radiological results, all knees were well-aligned at 1 year postoperatively and no periprosthetic loosening or radiolucent line around either component was found. Conclusion Primary total knee arthroplasty using fixed-bearing prosthesis is an effective procedure with good clinical and functional results and early mobilization.

Loxoscelismo Cutâneo em Portugal: Causa Rara de Dermonecrose

Cutaneous loxoscelism is an exceptional diagnosis in Portugal, regardless of the documented presence of Loxosceles rufescens.We report a 33-year old female patient presenting to our clinic after having visualized a bite from a spider in the inner aspect of the right thigh. Afterwards, she developed a warm, painful erythematous plaque, progressing to skin necrosis and torpid ulcer formation. Considering the failure of conservative measures, surgical debridement of the ulcer followed by repair using an O-Z plasty achieved good functional outcome. Definite diagnosis of cutaneous loxoscelism may be difficult since it relies on the visualization of the bite, capture of the spider for identification and typical clinical features. This case meets several criteria that allow the establishment of a causative link between spider bite and dermonecrosis. It is, to the best of our knowledge, the first diagnosis of loxoscelism reported in Portugal.

Cystectomy for Refractory Hemorrhagic Cystitis: Contemporary Etiology, Presentation and Outcomes

We evaluate the clinical presentation, management and outcomes of patients undergoing cystectomy for refractory hemorrhagic cystitis. We identified 21 patients with refractory hematuria treated with cystectomy at our institution between 2000 and 2012. Clot evacuation, bladder fulguration and bladder irrigation had failed in all patients before cystectomy. In addition, 45% of patients had received prior intravesical therapy (aminocaproic acid, alum or formalin), hyperbaric oxygen therapy (25%), nephrostomy tube placement for attempted urinary diversion (15%) and/or selective bladder angioembolization (5%). Median patient age at surgery was 77 years (IQR 72, 80) and 81% (17 of 21) of patients were male. The most common etiology for hemorrhagic cystitis was prior radiation therapy for prostate cancer (17, 81%). Median time from receipt of radiation to cystectomy in these patients was 91 months (IQR 73, 125). Median ASA® (American Society of Anesthesiologists) score at cystectomy was 3 and median preoperative hemoglobin was 10.2 gm/dl. Median length of stay after cystectomy was 10 days (IQR 7, 19). Severe (Clavien grade III to V) complications were noted in 42% of patients (8 of 19) and the 90-day mortality rate in this cohort was 16% (3 of 19). With a median postoperative followup of 13 months (IQR 4, 21), the 1 and 3-year overall survival was 84% and 52%, respectively. Cystectomy for hemorrhagic cystitis is associated with a high risk of perioperative complications and mortality, consistent with the baseline clinical status of this patient cohort and, as such, should remain a last resort to control bleeding after failure of conservative measures.

Superior mesenteric artery syndrome in a patient with cerebral palsy.

Superior mesenteric artery syndrome involves compression of the third part of the duodenum due to narrowing of the area between the aorta and the superior mesenteric artery (SMA). We will describe the case of a 34-year-old with cerebral palsy who presented with abdominal pain, nausea, vomiting, and weight loss and was diagnosed with SMA syndrome via CT-imaging. With failure of conservative measures, our patient underwent a duodenojejunostomy after which improvement in her weight as well as relief of her abdominal symptoms was noted. Given the rarity of this syndrome, physicians need to keep a high index of suspicion in order to prevent the damaging consequences.

Ultherapy Shrinks Nasal Skin after Rhinoplasty following Failure of Conservative Measures

Ultherapy Shrinks Nasal Skin after Rhinoplasty following Failure of Conservative Measures

V405 ROBOTIC TRANSVESICAL RECTOURETHRAL FISTULA REPAIR FOLLOWING A ROBOTIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyMale Voiding Dysfunction and Infection1 Apr 2013V405 ROBOTIC TRANSVESICAL RECTOURETHRAL FISTULA REPAIR FOLLOWING A ROBOTIC RADICAL PROSTATECTOMY Brian Linder, Igor Frank, Eric Dozois, and Daniel Elliott Brian LinderBrian Linder Rochester, MN More articles by this author , Igor FrankIgor Frank Rochester, MN More articles by this author , Eric DozoisEric Dozois Rochester, MN More articles by this author , and Daniel ElliottDaniel Elliott Rochester, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1794AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Rectourethral fistulas in men are most commonly seen following therapeutic interventions for prostate cancer, whether via prostatectomy, radiation therapy or cryotherapy. We present a video of a robotic assisted technique for surgical repair of recto-urethral fistula. METHODS A 61-year old male developed a rectourethral fistula near the bladder neck following a robotic assisted radical prostatectomy, likely secondary to an unrecognized rectal injury. After failure of conservative measures, including an indwelling Foley catheter and a suprapubic tube, he was referred to our center for surgical repair. Utilizing a 6-port transperitoneal setup, similar to that described for a robotic prostatectomy, we performed a robotic assisted transvesical rectourethral fistula repair. We initially proceeded with cystoscopy to identify the fistula and its location with respect to the ureteral orifices. Following port placement and lysis of adhesions, the bladder dome was identified through retrograde filling through the patientÆs catheter. Then, a horizontal cystotomy was made and the camera and working arms were advanced transvesically to the fistulous opening. A ureteral catheter was placed to aid in protection of the ureteral orifice during dissection. The fistula was then circumferentially mobilized to the base of the tract. The rectal wall and the bladder were closed individually using a 3-0 Maxon suture. Following this, the patientÆs suprapubic tube was exchanged and the cystotomy at the bladder dome was closed in two layers. The cystotomy closure was verified to be water-tight with bladder irrigation. Our colleagues in Colon and Rectal Surgery then performed a temporary loop-ileostomy. RESULTS The operative time was 200 minutes, including cystoscopy and temporary loop ileostomy formation. The patient had an uncomplicated postoperative course and was discharged on hospital day two. The indwelling Foley catheter and suprapubic tubes were removed at three weeks post-operatively following a cystogram showing no residual extravasation. CONCLUSIONS Given this result, a transvesical robotic assisted repair of a rectourethral fistula repair appears technically feasible in appropriately selected candidates. Longer follow up and larger case series will be needed to validate this finding. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e164-e165 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Linder Rochester, MN More articles by this author Igor Frank Rochester, MN More articles by this author Eric Dozois Rochester, MN More articles by this author Daniel Elliott Rochester, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transpiration stimulée afin d’améliorer l’équilibre hydro-sodé chez les patients hémodialysés : à propos d’un cas

Obtaining the desired dry weight in dialysis patients is challenging once residual diuresis has disappeared, considering the trend of increasing dietary salt intake and shortening dialysis time over the last 40 years. We describe the case of a 55-year-old patient of Sudanese origin, who presented excessive interdialytic weight gain and hypertension on maintenance hemodialysis. After failure of conservative measures, a therapy of daily hot water baths of 30minutes each on non-dialysis days was introduced. All clinical parameters improved, including potassium profile. In this article, we review the history, pathophysiological mechanisms, efficacy and possible side effects of this interesting, somewhat forgotten technique.

Advancement flap in the management of chronic anal fissure: a prospective study

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter.

Cranialization of the frontal sinus—the final remedy for refractory chronic frontal sinusitis

Chronic sinusitis can be a debilitating disease with significant impact on quality of life. Frontal sinusitis has a relatively low prevalence, but complications can be severe due to its anatomical location. After failure of conservative measures, typically endoscopic procedures are performed to improve the drainage of the frontal sinus. The cranialization of the frontal sinus is the final surgical measure, in which the affected frontal sinus is truly removed. In this study the authors describe the surgical technique of cranialization of the frontal sinus for refractory chronic frontal sinusitis, systematically search the literature for its application, and assess patient satisfaction in a cohort of consecutively treated patients after long-term follow-up. A consecutive cohort of 15 patients with refractory chronic frontal sinusitis was treated by cranialization of the frontal sinus and followed over a 20-year period (1989-2008) for the direct results and complications of the surgery. Long-term follow-up (mean 6.5 years) was obtained to assess the long-term effects of the cranialization. In all patients the signs and symptoms of chronic frontal sinusitis responded very well to the cranialization. Five patients had surgical complications, of which 2 were serious. One patient died of an unrelated cause and 1 patient was lost to follow-up. The remaining 13 patients had a long-term follow-up, which revealed that 12 of them thought that their life was better after the surgical procedure. Cranialization of the frontal sinus deserves consideration as the final remedy for refractory chronic frontal sinusitis after definite failure of other options.

Summary of Anticholinergic Pharmacotherapy Available for Overactive Bladder Dysfunction

Bladder over activity affects many individuals worldwide. Anticholinergic therapy has become standard first-line pharmacotherapy for overactive bladder dysfunction after failure of conservative measures. Several different anticholinergic agents are currently utilized in clinical practice. In this article, we review the mechanism of action of these drugs. This review aims to summarize the contemporary evidence base behind the use of these agents in terms of efficacy, safety, and patient satisfaction. Anticholinergic agents lead to improvements in symptoms of urgency, frequency, and urgency incontinence; however, there are associated side effects related to dry mouth, pruritus, constipation, and the central nervous system.

Surgical excision of a Juxtafacet cyst in the lumbar spine: A report of thirteen cases with long-term follow up

Context:Juxtafacet cysts of the lumbar spine are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. Surgical treatment is indicated when there is failure of conservative measures. Primary spinal fusion at the time of surgical excision of the cyst is a matter of controversy. Few reports have described long-term follow-up for surgical treatment of spinal cysts.Aim:The purpose of this study is to assess the long-term outcome of the surgical excision of a Juxtafacet cyst without spinal fusion.Study Design:This is a retrospective case series study, level IV evidence.Materials and Methods:This is a retrospective case series study on 13 patients with Juxtafacet cysts, who were treated with surgical excision of the cysts without spinal fusion. A questionnaire scoring system was used for evaluation of the surgical outcome.Results:The study was conducted on 13 patients, seven females (54%) and six males (46%), their age ranging from 38 to 69 years, with a mean age of 52 (±9.93 STD) years. The mean duration of the symptoms was 10.5 (±6.22 STD) months. All patients got benefit from surgery, with six excellent (46%), six good (46%), and one fair outcome (8%), with no surgery-related complications. The mean follow-up period of the patients at the time of this study was 4.2 years (±1.43 STD).Conclusion:Long-term follow-up for surgical excision of symptomatic Juxtafacet cysts without spinal fusion revealed excellent to good results in 92% of the patients, with a satisfaction rate of 80% (±8.41 STD).

The Surgical Treatment of Peroneal Tendinopathy (Excluding Subluxations): A Series of 17 Patients

Peroneal tendon pathology is rare, but is probably underestimated because it is frequently undiagnosed. It should always be in the differential diagnosis of lateral ankle pain. Surgical treatment of peroneal tendinopathy is indicated after failure of conservative measures. The aim of this retrospective study is to evaluate the medium-term clinical results of 17 patients operated for peroneal tendinopathy without tendon subluxation. A series of 17 patients composed of 7 women and 10 men with a mean age of 53.6 ± 4.6 (range 45 to 60) years were reviewed. The mean preoperative Kitaoka score was 46.7 ± 17.1 (range 25 to 69) points. All patients had radiological evaluation, which demonstrated hindfoot varus in 6 of the 17. Surgical interventions comprised synovectomy, debridement, suture-tubularization, fibrous resection, or tenodesis depending on the preoperative findings and also a valgus osteotomy (Dwyer) in 6 cases and ankle ligament reconstruction (modified Blanchet) in 1 case. All patients were reviewed clinically with a mean follow-up of 4.3 ± 3.8 years (range 16 months to 14 years). Average time to return to sport was 8.5 ± 10.4 months (range 3 months to 3 years). The mean time to return to work was 2.5 ± 1.9 (range 0 to 6) months. The mean postoperative Kitaoka score was 90.1 ± 11 (range 64 to 100) points with a statistically significant improvement to the preoperative score ( p < .0001). Sixteen patients were satisfied or very satisfied with their treatment (94.1%). Surgical treatment of peroneal tendinopathy after failed conservative treatment leads to significantly improved function. It is a simple treatment to undertake, which gives a good outcome for both the patient and surgeon.

Laparoscopy for acute small bowel obstruction: indication or contraindication?

Acute small bowel obstruction (SBO) is a relatively common cause of emergency hospital admission, most frequently due to postoperative adhesions. With increased experience and technical advances in laparoscopic surgery, the laparoscopic management of acute SBO has become feasible and potentially superior to the open approach. This retrospective study presents the authors' experience with laparoscopic treatment of SBO over a 6-year period to assess the feasibility, efficacy, and clinical outcome of this therapeutic method and to present the author's methodology. From April 2003 to January 2009, 32 patients hospitalized in the author's department for acute SBO underwent elective laparoscopic treatment after failure of conservative measures. Standard laparoscopic techniques and instruments were used. Postoperative adhesions were identified in 62.5% of patients (n=20) as well as tumor (n=3), incarcerated ventral hernia (n=4), incarcerated femoral hernia (n=3), internal hernia (n=1), and Crohn's disease (n=1). The conversion rate was 18.7% (n=6), and the postoperative complication rate was 3.25% (n=1). The mean operative time was 78 min. Bowel function returned after a mean of 3.2 days, and the mean hospital stay was 4.6 days. The laparoscopic treatment of acute SBO is an attractive alternative to the open approach. However, it must be kept in mind that surgery longer than 120 min is a significant predictor of postoperative morbidity, that bowel injury may be missed at the time of operation and can be avoided with improved surgical techniques and appropriate instrumentation, that lysis of all intraabdominal adhesions is unnecessary, and that a low threshold for conversion should be maintained, especially in cases of severe, dense, extensive adhesions.

Noninvasive and invasive ventilation in acute respiratory failure associated with bronchiectasis

To describe the outcomes of patients with bronchiectasis and acute respiratory failure (ARF) treated with noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) after a failure of conservative measures, and to identify the predictors of hospital mortality and NIV failure. Retrospective review of bronchiectatic patients on NIV (n = 31) or IMV (n = 26) for ARF over 8 years in a medical intensive care unit (ICU) experienced in NIV. At baseline, the NIV group had more patients with acute exacerbations without identified precipitating factors (87.1 vs. 34.6%, p < 0.001), higher pH (mean 7.25 vs. 7.18, p = 0.008) and PaO(2)/FiO(2) ratio (mean 249.4 vs. 173.2, p = 0.02), and a trend towards a lower APACHE II score (mean 25.3 vs. 28.4, p = 0.07) than the IMV group. There was no difference in hospital mortality between the two groups (25.8 vs. 26.9%, p > 0.05). The NIV failure rate (need for intubation or death in the ICU) was 32.3%. Using logistic regression, the APACHE II score was the only predictor of hospital mortality (OR 1.19 per point), and the PaO(2)/FiO(2) ratio was the only predictor of NIV failure (OR 1.02 per mmHg decrease). The hospital mortality of patients with bronchiectasis and ARF approximates 25% and is predicted by the APACHE II score. When selectively applied, NIV fails in one-third of the patients, and this is predicted by hypoxemia. Our findings call for randomised controlled trials to compare NIV versus IMV in such patients.

Non-Reversed Appendicostomy for Antegrade Continence Enema in the Treatment of Encopresis

Background/Purpose: Constipation in children is considered when stool frequency is less than three times per week. Encopresis represents 80-90% of children with fecal incontinence. Operative strategy for management of encopresis ranges from resectional surgery to myotomy. The objective of the study was to evaluate the efficacy of non-reversed appendicostomy without antireflux mechanism for management of encopresis in children. Materials & Methods: The study included 35 patients with severe idiopathic constipation and encopresis with failure of conservative measures. They were subjected to non-reversed appendicostomy without anti-reflux procedures. Results: The incidence of complications was 22.8% and included stomal leak, stricture, retraction and granulation tissue formation. False passage during dilatation occurred in one case. Antegrade continence enema effectively controlled constipation and encopresis. Conclusion: Non-reversed appendicostomy without antireflux mechanism is safe and rapid with minimal incidence of leakage. Constipation and encopresis was effectively controlled with this simple procedure. Index Word: Constipation, encopresis, antegrade continence enema.

Surgical treatment for tibialis posterior dysfunction

Dysfunction of the tibialis posterior tendon is the most common cause of acquired flatfoot deformity in adults. Early treatment with orthotics may often prevent progression of the dysfunction into a fixed deformity. Late presentation or failure of conservative measures may need to be corrected by surgical means. In this review we will discuss the anatomy, etiology, diagnosis and treatment of tibialis posterior dysfunction. Surgical options for dealing with patients who have failed nonoperative measures will be covered, outlining outcomes, recent advances and future directions in the treatment of this complex disorder.

Management of lower gastrointestinal bleeding after colorectal resection and stapled anastomosis

Although limited haematochezia with the first bowel movement is frequent in patients undergoing colorectal resection, postoperative life-threatening lower gastrointestinal bleeding is very rare. The purpose of this study was to review our results in the management of this complication. We analysed the cases of patients with severe lower gastrointestinal bleeding after colorectal surgery from 2000 to 2006 in our hospital. We studied the general characteristics, diagnostic data, therapeutic management and outcome. We also reviewed the published articles regarding this issue. This complication appeared in 7 (0.5%) of 1,389 colorectal procedures in the study period. In all the patients the anastomosis was stapled. In six of the seven patients bleeding resolved with conservative treatment including endoscopy. However, one patient required surgical treatment. There was no mortality and there were no anastomotic leaks in these seven patients. Severe lower gastrointestinal bleeding after colorectal resection and stapled anastomosis is a rare complication. Only in unstable patients or failure of conservative measures is surgery indicated.